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WASHINGTON, DCAbout two-thirds of U.S. primary care
physicians reported in 2004-05 that they couldnt get outpatient mental health
services for their patientsa rate that was at least twice as high as for
other services, according to a national study funded by the Commonwealth Fund
published today as a Web Exclusive in the journal Health Affairs.

Conducted by Peter J. Cunningham, Ph.D., a senior fellow at the Center for
Studying Health System Change (HSC), the study found that more than half of
the primary care physicians reporting problems getting mental health services
for their patients cited lack of or inadequate insurance coverage, health plan
barriers and shortages of mental health providers, as "very important"
reasons their patients couldnt get care.

The Health Affairs
article, titled "Beyond Parity: Primary Care Physicians Perspectives
on Access to Mental Health Care," is based on findings from HSCs nationally
representative 2004-05 Community Tracking Study Physician Survey, supplemented
by other sources to estimate the supply of mental health providers, levels of
insurance coverage, existence of state mental health parity requirements and
health maintenance organization (HMOs) penetration in 60 communities across
the country. The physician survey had a 52 percent response rate and included
information from 2,900 primary care physiciansgeneral internists, family/general
practitioners and pediatricians.

"From the perspective of primary care physicians, the study findings suggest
that lack of access to mental health services is a serious problemmuch more
serious than for other commonly used medical services," Cunningham said.

The survey asked physicians about their ability to obtain the following services
for their patients: outpatient mental health services, referrals to other specialists,
diagnostic imaging services and nonemergency hospital admissions. Almost 67
percent of the primary care physicians (PCPs) reported they couldnt get mental
health services for their patients, compared with 33.8 percent reporting they
couldnt get specialist referrals, 29.8 percent reporting they couldnt get
diagnostic imaging and 16.8 percent reporting they couldnt get nonemergency
hospital admissions.

"With the Obama Administration and Congress engaged in a historic effort
to reform our fragmented health care system, these findings underscore the need
to cover everyone with comprehensive and affordable coverage and to move towards
a more organized, integrated health system," said Commonwealth Fund Assistant
Vice President Sara Collins.

The study also found that PCPs probability of reporting mental health care
access problems for their patients varied by physician practice, health system
and policy characteristics. For example, pediatricians were more likely than
other PCPs to report problems getting mental health services for their patients
because of health plan barriers and shortages of mental health providers but
not because of lack of or inadequate coverage. This finding is consistent with
other reports indicating severe shortages of child and adolescent psychiatrists.

The article concludes that "the fact that a high percentage of PCPs cited
health plan barriers or inadequate coverage as important reasons for the lack
of access is consistent with much of the recent policy focus on parity in mental
health benefits. Indeed, these concerns are lower in states that implemented
parity legislation prior to the 2008 national parity legislation, although the
effects are relatively modest. Even with national parity legislation, large
gaps in mental health access will likely remain, and the new law will have no
effect on the severe access problems of the uninsured as well as problems related
to the shortage of mental health care providers."

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The Commonwealth Fund is a private foundation supporting independent research
on health policy reform and a high performance health system.

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The Center for Studying Health System Change is a nonpartisan policy research
organization committed to providing objective and timely research on the nations
changing health system to help inform policy makers and contribute to better
health care policy. HSC, based in Washington, D.C., is funded principally by
the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy
Research, Inc.

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Health Affairs, published by Project HOPE, is the leading journal of health
policy. The peer-reviewed journal appears bimonthly in print with additional
online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.